By Mariam Jashi MD, MPH, MPA
Regional Chair for Eastern Europe and Central Asia, Global Parliamentarians Network UNITE
Advisory Board Chair, Tbilisi Medical Academy

The COVID-19 pandemic claiming 5 million lives has changed every nation. The novel virus brought unprecedented human suffering both to low- and middle-income countries with fragile health systems and wealthy states with stronger baseline capacities. The multi-sectoral impact of the pandemic, driving 150 million people into the extreme poverty, further aggravated the state of well-being in resource-limited countries.

At the same time, the world has witnessed priceless efforts of medical professionals and other front-line workers who through their daily struggle gained indispensable time for researchers and innovators to develop new vaccines of proven efficacy.

Every country has its own heroes of the pandemic war and efforts invested by national, regional and global health authorities and individual professionals cannot be underestimated.

However, while recovering from the initial shocks of the pandemic, and analyzing the achievements and challenges, critical lessons emerge to learn from and build our future actions for better compliance to regulations and stronger public health impact.

The list of lessons and questions brought by the pandemic is extensive, but let us concentrate on the problematic observations from the global heath governance perspective.

• International Health Regulations (IHR) that should have guided the pandemic prevention, preparedness and response, has not worked adequately. Enforcement of IHR de facto remains voluntary for member states of the United Nations and their respective national authorities.
• Daily reporting on COVID-19 cases and related morbidity and mortality statistics was publicly available through the World Health Organization (WHO) or other sources. Though the quality and transparency of the reported data remains questionable for retro- or prospective analysis.
• Countries with still fragile democratic institutions have witnessed undue political influence over the COVID-19 response. As reported by the Freedom House, “since the coronavirus outbreak, the condition of democracy and human rights has grown worse in 80 countries”.
• Decision-making on restrictive measures during the pandemic was not always transparent, let alone evidence-informed. National coordination councils for pandemic response would have benefited from inclusion of health professionals from multiple political parties. The latter could have brought critical insights to the process, and improve national-level endorsement and public acceptance of the pandemic-related regulations.
• While WHO was providing continuously updated guidance how to act against the new virus, there was no independent, national or international monitoring mechanism to consistently assess compliance of the country-level response to the best available evidence and recommendations.
• The pandemic revealed major inequalities in access to basic prevention commodities and services (e.g., testing, face masks, personal protective equipment). And only through the effective action of global stakeholders, ACT-Accelerator and COVAX partnerships, people in resource-limited settings could gain access to life-saving vaccines.
• Finally, the anti-scientific and anti-vaccination propaganda was not addressed adequately at the global level, that could have saved millions and reaffirm the effectiveness of the pandemic response.

What could be the solution?
Continuing business as usual cannot be an option. The global health governance should be strengthened, both within the scope and regulations of the World Health Organization and beyond.

There is a need for a new, politically and financially independent global health inspectorate platform that could ensure stronger monitoring and external validation of actions on the ground, including the enforcement of IHRs, transparency of data reporting and decision-making throughout the pandemic prevention, preparedness and response phases.

The recent Lancet Health Policy journal article “A global public health convention for the 21st century”[ https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00070-0/fulltext] authored by members of the Panel for the Global Public Health Convention, comprehensively explores the issue with 10 specific recommendations.

While, reaffirming the position of the authors, let me further elaborate on the topic:

• The leadership and the role of WHO in the pandemic response was and remains critical as a lead global health authority.
• However, the guiding rules and regulations of the organization, might not be able to ensure hosting of a new or stronger monitoring and inspectorate body, that would be free of political influence.
• The scarce financial resources available to WHO, largely through member states’ contributions, will neither allow the organization to independently establish a new or stronger monitoring and inspectorate system.
• Based on the success stories of GAVI and the Global Fund, the global public-private partnerships (PPP) that made unprecedented contribution to international efforts for immunization, HIV, TB and Malaria, the world needs a new, independent global PPP that could secure political will and resources for stronger pandemic prevention, preparedness and response.

As the former Member of the Parliament of Georgia, Deputy Health Minister and the staff member of the United Nations, I call upon my colleagues and fellow politicians to critically assess the pandemic response in their countries and unite forces for strengthening the global health governance for future action. The first foundational step in the process can be the endorsement of the new Global Public Health Convention.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00070-0/fulltext